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Ask Well: Do Monogamous Women Still Need a Pap Smear?

Q

Do monogamous women need pap smears?

Why are monogamous women who are negative for HPV still given pap smears?

Asked by mashed potatoes • 1091 votes

A

The annual Pap smear has been a cornerstone of women’s health for at least 60 years, and is credited with preventing millions of deaths from cervical cancer. However, in 2012, the United States Preventive Services Task Force made decisive recommendations advising women to undergo Pap smear screening less often. The goal is to test women often enough to catch early warning signs of cervical cancer, but not so often that women are subjected to unnecessary and invasive tests.

Given that most cases of cervical cancer are linked to the sexually transmitted human papillomavirus, or HPV, it would seem that a monogamous woman who tests negative for HPV would not need regular Pap smears. However, doctors advise that these women should still undergo Pap smears as recommended for their age and medical history.

Why? One reason is that many HPV infections clear up on their own without causing any problems, and it’s possible that a woman who tests negative for HPV still harbors a dormant form of the virus. While dormant HPV does not appear to be an immediate health risk or contagious to a partner, it could become active again if the immune system is compromised by another virus or health problem. A Pap smear detects cervical cell changes that can result from a persistent case of HPV. A separate test, called an HPV test, detects only the presence of an active virus.

“HPV never leaves your body,” said Dr. Laura Corio, an obstetrician and associate professor at Mount Sinai Hospital in New York. “It can come out various times in your life.”

Then there is the more complicated issue of monogamy. Just because a woman is monogamous, that doesn’t mean her partner is or always will be. Men and women in the most committed relationships may stray on occasion, and many will never admit this, even to their doctor. Estimated infidelity rates range from about 25 percent of couples to as high as 70 percent. A new sexual partner by either person in a relationship is a risk factor for the woman’s contracting HPV.

Because of the possibility of a dormant virus and the potential for infidelity, doctors err on the side of caution and continue to offer Pap smears to monogamous women.

Under the current guidelines, women should be screened no more than every three years. Women are advised to begin screening at age 21 regardless of sexual history. The task force also recommends against Pap tests for women over 65, as long as they have had adequate prior screening and are not otherwise at high risk for cervical cancer.

Women over 30 who do not want a Pap test every three years can opt for one every five years along with an HPV test. Women who have unusual symptoms, an unusual Pap test result or a history of cervical dysplasia, cervical cancer, H.I.V. or other illnesses are likely to be screened more frequently.